EP2105098A1 - Pressure wave therapy device with integrated x-ray device - Google Patents
Pressure wave therapy device with integrated x-ray device Download PDFInfo
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- EP2105098A1 EP2105098A1 EP08005803A EP08005803A EP2105098A1 EP 2105098 A1 EP2105098 A1 EP 2105098A1 EP 08005803 A EP08005803 A EP 08005803A EP 08005803 A EP08005803 A EP 08005803A EP 2105098 A1 EP2105098 A1 EP 2105098A1
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- European Patent Office
- Prior art keywords
- ray
- pressure wave
- patient
- wave therapy
- stand
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/225—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves
- A61B17/2256—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves with means for locating or checking the concrement, e.g. X-ray apparatus, imaging means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/44—Constructional features of apparatus for radiation diagnosis
- A61B6/4429—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units
- A61B6/4435—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units the source unit and the detector unit being coupled by a rigid structure
- A61B6/4441—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units the source unit and the detector unit being coupled by a rigid structure the rigid structure being a C-arm or U-arm
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/225—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves
- A61B17/2255—Means for positioning patient, shock wave apparatus or locating means, e.g. mechanical aspects, patient beds, support arms, aiming means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/12—Devices for detecting or locating foreign bodies
Definitions
- the present invention relates to a pressure wave therapy device with integrated X-ray system.
- Pressure waves d. H. mechanical and sometimes also referred to as "acoustic" waves are used in various ways for therapeutic treatment.
- shock wave lithotripsy ie the crushing of body calculi, especially stones, with focused pressure waves of large amplitudes and with steep rising edges.
- individual pulses are directed to the calculus whose first "half-wave" corresponding to compression dominates in terms of edge steepness and amplitude as well as therapeutic effect, whereas already the next subsequent half-wave, which corresponds to an expansion, is significantly less pronounced.
- Such pulses are used repeatedly on a regular basis.
- shock waves Similar methods with shock waves are also known for other indications, such as for the treatment of poorly healing bone fractures.
- the invention also relates to pressure wave therapies with actual, ie continuously oscillating waves. These can be used in a focused manner for heating body tissue, for example for the so-called thermal ablation of tumors.
- unfocused pressure wave therapy is also known, the present invention is directed to focused wave applications (which include pulses, see above).
- focused and unfocused waves can be difficult, in the following, in any case, only those therapies are to be used in which the pressure waves are consciously concentrated in a more or less extended body region in order to achieve increased intensities, pressures or edge slopes.
- X-ray localization and X-ray monitoring during shockwave lithotripsy are known. If, for example, the patient has been positioned on a patient couch, it must first be determined exactly where the area to be treated is located. For this purpose, a vertical X-ray fluoroscopy is conventionally carried out first. As a rule, the region to be treated, for example the stone, will appear in the X-ray image, but not be centered. You can then make a horizontal shift (either the bed or the stand with the X-ray system) until the stone is centered.
- two different X-ray images from different directions are basically necessary, for example at an angle of 30 ° to one another. So a second fluoroscopy is done in a second direction to be able to set the correct height of the stone, for example, to adjust it to the so-called isocenter.
- the patient bed can be adjusted in height. Only when the stone is three-dimensional centered and thus lies in the pressure wave focus, it can be disintegrated.
- an X-ray image in only one direction can be combined with other imaging methods or other non-imaging detection possibilities.
- a combined application of X-ray diagnostics and pressure wave therapy is often desired.
- combined systems are known, the X-ray systems, also in the imaging direction adjustable X-ray systems with pressure wave therapy devices, in particular Stoßwellenlithotriptern combine.
- a device for pressure wave therapy on human or animal body with a focusing pressure wave therapy device, an integrated X-ray system, the X-ray source and image pickup device are each attached to support arms on a stand, and a patient bed next to the stand, the X-ray system and the pressure wave therapy device for Detecting an abdominal region of a patient are designed on the patient bed and the X-ray system can radiate vertically through the abdominal area, characterized in that the device is designed so that the stand on the one hand and the X-ray source and the image pickup device of the X-ray system on the other hand in the vertical irradiation of the abdominal region in vertical Projection form a connecting line which forms an angle of at most 75 ° to a longitudinal axis of the patient bed.
- the invention is also directed to advantageous uses of this device and preferred embodiments according to the dependent claims.
- the description is no longer explicitly between the device category and the usage category so that the description is basically relevant to both claim categories.
- the basic idea of the invention is to improve the spatial conditions when using a combined pressure wave therapy and X-ray device.
- access to the patient is of particular interest, specifically in this invention for the abdominal region, ie abdominal region and abdomen.
- Conventional devices have a stand directly next to the patient bed, which carries the X-ray system on arms. This stand stands on one side next to the patient's couch center, blocking access to the abdominal area from this side.
- access from both sides is an advantage.
- lateral areas of the patient on both sides may need treatment, for example, both kidneys.
- the doctor would like to stand directly on the side being treated, especially when assisted by external kidney access. Therefore, when using conventional devices, the patient is rearranged when changing the treated side.
- an eccentric arrangement of the stand can be achieved, ie next to the patient bed and also on one of its longitudinal sides, but not next to the abdominal area.
- An arrangement next to the head area or next to the foot area is therefore possible.
- the one line is a horizontal line, ie the vertical projection, imaginary connecting line between the stator and the X-ray source and the X-ray image recording device in the vertical transmission direction of the X-ray system.
- This line represents the longitudinal extension of the X-ray system structure on the stand.
- the other line is the longitudinal direction of the patient bed, ie from the head area to the foot area or vice versa.
- an angle of at most 75 ° should exist between the two lines, whereas the state of the art here provides an angle of 90 °. Since a vertical alignment of the X-ray system when radiating the abdominal region is assumed, means this angle is a quantification of the eccentric arrangement according to the invention. Particularly preferred are angles of at most 70 °, 65 ° or even at most 60 °.
- the staff can now reach the abdominal area of both treatment from both sides.
- an arrangement of the stand next to the head area still remain the foot side of the treatment table and the opposite side of the treatment table in the head area free, especially for anesthesia, which indeed requires a head access.
- even more favorable arrangement next to the foot area of the X-ray source area remains accessible from three sides, at least as far as the X-ray system.
- the arrangement according to the invention for the combined device means only a suitability.
- the device may also be suitable for deviating construction or use.
- the conventional devices are not suitable for the arrangement according to the invention.
- the invention is additionally directed to the use of the device according to the invention, in which the corresponding arrangement is present.
- the X-ray system is adjustable in its imaging direction, by pivoting an arc, which is formed from the arms on which the X-ray source and the image pickup device are mounted.
- an arc which is formed from the arms on which the X-ray source and the image pickup device are mounted.
- either the X-ray source or the image pickup device is moved closer to the stand and the other part thereof away.
- a rotational movement about a horizontal axis which is perpendicular to the described connection line between the X-ray source and the image recording device on the one hand and the stator on the other hand in the vertical projection is preferred.
- the pivoting movement can also be designed differently, ie not with a fixed axis of rotation. In the preferred variants with a time-constant axis of rotation, this preferably passes through the focus area of the pressure wave device.
- the X-ray imaging direction can be tilted out of the exactly vertical position.
- a region relevant for pressure wave therapy can be located in the abdominal area.
- the invention also allows in this embodiment, a pure X-ray location and X-ray navigation.
- a further preferred embodiment provides an additional axis of the X-ray system, which is realized in that the arc is rotatably mounted on the column.
- this axis is preferably not horizontal, but oblique.
- An angular range between this axis of rotation and the horizontal is preferably between 30 ° and 60 °, in particular between 40 ° and 50 °. Since rotations about the X-ray imaging axis itself are not meaningful, in principle arbitrary angular positions can be set with these two rotational degrees of freedom, at least as far as the structural conditions, in particular the space above and below the patient bed and the extent of the X-ray source and the X-ray image recording device allow.
- lateral tilting of the X-ray axis that is to say rotated about the patient's longitudinal axis
- cranio-caudal tilting that is to say about a horizontal axis transversely to the patient
- beam direction inversions can be realized.
- the cranio-caudal position is usually only approximately reached, but nevertheless so designated.
- the pressure wave therapy device is movable. Preferably, it is mounted on the sheet and moved along the arc, which configuration is again preferably isocentric. The center of the travel path of the wave therapy therapy device, the intersection of all possible X-ray axes and the focus range of the wave therapy therapy device thus preferably coincide.
- the pressure wave therapy device can assume a parking position and a working position. In the working position, the focus area is in the X-ray path. In the parking position, the pressure wave therapy device is located entirely outside the X-ray path, as far as it is used for imaging, in order to disturb as little as possible. Ideally, the movement mechanism for the movements between these two positions is also movable along the arc and operates in the various pivotal positions of the wave therapy device.
- the pressure wave therapy device may be pulled out of the couch during the pivoting operation and in certain therapeutically relevant positions, such as under the couch with vertical Beauftschungscardi up, laterally next to the patient just above the couch with horizontal direction and above the couch with vertical direction of downward loading, be movable in a respective working position.
- lateral adjustment options in order, in particular in the preferred isocentric embodiment, to bring the region of interest in the abdominal region into the region covered by the X-ray system and the pressure wave therapy device.
- two horizontal adjustment directions can be provided.
- it depends on the relative arrangement between the stand and the patient bed, so that the patient bed and / or the stand can be adjusted.
- Preference is given to a stand adjustment because this results in no shock to the patient and does not have to be paid to any outgoing lines in connection with catheters, anesthesia or other.
- a stand adjustment is not necessarily meant a method of the stand as a whole across the floor. It is sufficient for the stand adjustment when the joint construction of pressure wave therapy device and X-ray equipment, so in particular the bow, is moved. This adjustment is preferably also vertical.
- the pressure wave therapy device can already be adjusted to the region to be treated by the described Reiativeingnarison between stand and the patient bed. I. d. R. is then an additional adjustment in the direction of the X-ray device necessary.
- a further transmission direction for example different from the vertical direction, preferably below 30 ° to the vertical, should be adjustable. This can be achieved for example by a rotation of the C-arm.
- the setting itself can also be done by a setting of the pressure wave therapy device (including X-ray device) or by a corresponding readjustment, such as a height adjustment, the patient bed.
- a setting of the pressure wave therapy device including X-ray device
- a corresponding readjustment such as a height adjustment, the patient bed.
- the height adjustment of the lounger because it also a favorable height adjustment for the rise of the patient can be achieved.
- the pressure wave source can be a hollow coil.
- a passage of the X-rays through the pressure wave therapy device should be possible, preferably at least axially.
- the X-ray system and the pressure wave therapy device can be operated simultaneously in each vertical working direction.
- there is even another possible passage direction for X-rays through the pressure wave therapy device which is slightly inclined with respect to the axial direction, preferably for a laterally tilted second X-ray image in an arrangement of the wave therapy device in its working position.
- the lateral arrangement of the pressure wave therapy device disturbs the X-ray image i. d. R. not, at least not if it is close to the vertical axis or even with a cranio-caudal position.
- the stand can have a foot with a somewhat larger extension in the direction of the connecting line between the X-ray source and the imaging device on the one hand and the stand in order to be able to support the center of gravity of the overall construction.
- This foot can make it difficult to get close to the patient bed with its cladding, because it collides with support structures of the patient bed or at least restricts the space possibly required for other purposes under the patient.
- the stand is preferably bevelled in the relevant area, that is to say the area facing the X-ray source and the X-ray image recording device.
- a meaningful support can be combined with a slim as possible in the problematic area design.
- the bevel of the cladding should thereby comprise at least half of the X-ray source and the X-ray image recording device facing side, the non-tapered region should therefore make up at most half.
- a non-tapered remainder is provided centrally and two chamfers are provided on both sides thereof.
- the chamfers need not have straight flanks, but should in any case be beveled at an angle in the range between 10 ° and 60 °, preferably at least 15 ° and preferably at most 45 °. Side of a non-tapered area of at most half of the considered front panel so appropriate angle should be achieved.
- the stand in the oblique orientation according to the invention can be moved quite close to the patient bed without substantially or even protrude below the patient bed and without obstructing the freedom of movement (especially in the foot) of the practitioner who is on the side of the couch.
- this also applies in various arrangements, that is, to the right or left of the patient bed or next to the head or foot area.
- a further preferred embodiment of the stand has a device shelf for other medical devices, such as for endoscopy or control and Evaluation devices, an ultrasonic diagnostic unit u. ⁇ .
- This rack (or “rack") is arranged “up” in the sense that it is mounted at least partially higher than the patient bed, ie the patient level. It can thus be kept out of the foot area, which may be needed for other things and is more accessible and thus easier to use or clean.
- this arrangement is ergonomically more favorable for the operation of the devices as an arrangement under waist height.
- the device shelf is arranged on the actual stand, as the embodiment shows.
- the patient couch preferably has an eccentric column to clear the area below the abdominal area of the patient.
- a part of the X-ray system can be pushed under the abdominal area.
- the patient bed has a supporting foot extending from the eccentric column, which extends relatively flat on the floor to at least the abdominal area in order to ensure sufficient stability of the patient bed.
- This embodiment is particularly suitable for movable couches that are not firmly bolted to a floor. Again, reference is made to the illustrative embodiment.
- FIGS. 1a, b and 2 first, a patient couch 1 with a lying plate 2 articulated in a head support, an upper body support and two leg supports is mounted.
- the lying support 2 is mounted on a pillar 3 which is covered by a bellows cover and which lies under the head part and the adjacent area of the upper body part of the lying platform 2, as the later described in more detail FIG. 3 shows.
- the column 3 is supported by two substantially to the longitudinal direction of the couch (in FIG. 1 horizontally in the plane of the drawing) parallel longitudinal feet 4 on the ground and is as in FIG. 2 Recognizable to some extent, can be moved over these rollers on rollers.
- a stand 5 which carries a substantially semicircular C-arm 6.
- an X-ray image intensifier 7 as an image recording device and below an X-ray source 8.
- the X-ray source 8 is below the deck plate 2 of the patient bed 1 and next to the column 3, see. FIG. 4 .
- the X-ray direction running between the X-ray source 8 and the image intensifier 7 extends vertically through the middle to lower region of the upper body support of the bed plate 2, ie the abdominal region in the center of the patient couch 1.
- FIGS. 1a and b clearly show that the stand 5 is eccentric next to the patient bed 1, in FIG. 1a next to the foot area and in FIG. 1b next to the head area.
- the vertical plan view of the C-arm 6 illustrates the already repeatedly mentioned reference line, namely the connecting line between the stator 5 and X-ray source 8 or image intensifier 7, here at 45 ° to the patient's couch longitudinal direction, namely the horizontal in the plane of the FIG. 1 . runs.
- the abdominal region of the patient couch 1 is freely accessible from both sides.
- FIG. 1a and the leg area in FIG. 1b Finally one recognizes (compare also FIGS.
- the oblique edges form an angle of about 20 ° to the above-mentioned connecting line and run into a narrow in relation to the width of the stator 5 foot, the stand 5 to Patient couch 1 supported out.
- the foot is only about a quarter as wide as the stand 5 itself.
- FIG. 2 shows a built on the stand 5 equipment rack 9 with pivoting or rotating shelves for a variety of devices, such as endoscopy equipment, operating devices for video cameras, pumps or a so-called. Stone laser for laser-based stone destruction.
- This device shelf 9 is constructed on a support rod 10 on the stand 5, is thus in the vertical projection of FIG. 1 It is thus ergonomically located, away from the floor area, which saves space and facilitates cleaning and otherwise protects the equipment, and in a practical way firmly with connected to the stand 5.
- This is namely also movable and can be moved with the C-arm 6 and the device rack 9 in other positions in the same room or in another room.
- At the working position of the stand 5 is securely fixed to the ground, z. B. by lowering.
- the support rod 10 passes through the device shelf 9 and above and beyond and contributes to a lever arm two large touch-operable flat screens for displaying X-ray images or images of the video camera, ie from endoscopy, essential for the user data, ultrasound images, etc ,
- FIG. 2 One recognizes in FIG. 2 in that the C-arm 6 deviates from FIG. 1 not next to the foot area, but next to the head area of the patient bed 1 is arranged, again at 45 ° to the patient's couch longitudinal direction.
- This arrangement is also according to the invention, offers the same advantages in terms of accessibility of the abdominal area, but does not provide the same good accessibility of the head area as the arrangement FIG. 1 , Instead, the accessibility of the leg area is improved.
- the genital area and in particular the ureter between the legs of the patient could be better accessible, such as when from there endoscopes or catheter should be introduced.
- FIG. 2 One recognizes in FIG. 2 in that the C-arm 6 is held in a shoe-like guide 11 on the stand 5.
- the C-arm can be moved along its arcuate shape, which corresponds to a rotation about a horizontal axis, which results in the vertical projection of the C-arm 6 FIG. 1 perpendicular and through the abdominal region of the patient and through the x-ray beam.
- This is on the Figures 5 ff.
- a linearly operating lifting device is provided, with which the vertical height of the deck plate 2 can be adjusted above the ground to position the patient vertically.
- one or two laterally acting linear drives could also be provided in the column 3 in order to be able to position the patient in two or three dimensions.
- the two lateral degrees of freedom are realized in the stator 5, which carries the C-arm 6.
- the C-arm 6 is thus two-dimensionally adjustable by two horizontally acting linear drives and the deck plate 2, as mentioned, vertically.
- the patient relative to the C-arm 6 or vice versa the C-arm 6 relative to the patient can be positioned three-dimensionally.
- FIG. 3 shows the situation FIG. 2 This arrangement is favorable in some cases, for example if the doctor requires a relatively large amount of space above the patient and if the smaller X-ray source 8 is less obstructive than the image intensifier 7.
- the shockwave lithotripter used in FIG. 3 is not shown, are arranged above the patient and is then closer to the X-ray source 8, to act in this way less shading during the passage of the X-rays through the hollow geometry, see.
- FIG. 8 and 9
- FIG. 2 again, for the same reasons, it is preferable in cases where the shockwave lithotripter is disposed under the patient support plate 2.
- the arrangement is in FIG. 2 Radiation protection technically cheaper because the X-ray source 8 is shielded more under the plate by the deck plate and possibly other not shown devices.
- FIGS. 4a-c correspond FIG. 2 , but also show a on the C-arm 6 along this movable further guide shoe 12. This is based on the C-arm 6 radially inside and not, like the shoe-like guide 11 of the C-arm 6 itself, radially outward.
- the guide shoe 12 contributes to two joint axes in the FIGS. 4a-c shown in its movement lever linkage to which a in the figure for the sake of simplicity cylindrically illustrated shockwave lithotripter 13 is mounted.
- the lithotripter 13 can in the in FIG. 4a Park position shown are moved, in which he is as far as possible approximated to the C-arm 6. From this parking position he can according to the FIGS.
- FIG. 5 shows a side view of the stand 5 with equipment shelf 9, C-arm 6 and X-ray system 7, 8.
- the patient bed 1 is omitted here for simplicity, the viewing direction is different from Figure 4a - c exactly at the side, so that the C-arm 6 runs parallel to the plane of the drawing.
- a rotation axis 14 can be seen, around which the guide 11 and the C-arm 6 can be rotated and which is less than 45 ° to the horizontal.
- FIG. 5 also shows symbolically the X-rays emerging from the X-ray source 8, which pass through the lithotripter, ie through a central opening therein, in order to reach the image intensifier 7.
- This coaxial arrangement of the lithotripter 13 and the X-ray system 7, 8 is known per se and is based on a hollow coil technology of the lithotripter 13.
- FIG. 6 shows in comparison to the lithotripter 13 in the parking position and thereby larger opening angle of the X-rays, so the larger captured image area and the larger image format.
- This fundamental relationship of the swivelability of the lithotripter 13 in the X-ray path and the limitation of the image area applies in principle to other positions of the C-arm 6, for example in FIG. 8 ,
- FIG. 7 corresponds to FIG. 5
- the C-arm 6 was pivoted about an axis perpendicular to the plane and through the focal point of the lithotripter 13 current axis.
- the C-arm 6 has been moved in the guide 11 and compensated for this shift by a method of the guide shoe 12.
- the position of the lithotripter 13 is thus opposite to the FIG. 5 unchanged.
- the swivel angle is 30 °.
- the lithotripter 13 shows a second passage for the X-rays, which in turn somewhat limits the aperture angle of the X-rays, as shown in figurative form.
- the first direction passes through the cylindrical source coil, the second at 30 ° tilted by the source, but past the coil. If the lithotripter 13 in the park position accordingly FIG. 6 is moved, this restriction does not exist.
- the drawn C-arm position allows a lateral X-ray image.
- FIG. 8 corresponds to FIG. 5
- This position can be achieved by moving the lithotripter 13 into the parking position according to FIG. 6 , a pivoting of the C-arm 6 in one FIG. 7 similar position and (also simultaneous) rotation of the C-arm 6 about the axis of rotation 14 by 180 °, a swing back into a vertical arrangement of the X-ray system 7, 8 and then back into the in FIG. 8 illustrated treatment position moving the lithotripter 13.
- the shock wave treatment is carried out from above and is opposite to the X-ray imaging direction FIG. 5 inverted.
- the lithotripter 13 is moved to the parking position (not shown), there is much room above the patient, because the X-ray source 8 is smaller and farther away from the treatment center than the image intensifier 7.
- the guide shoe 12 can be moved so that the lithotripter 13 can be brought laterally to the patient.
- the focus area of the lithotripter 13 remains centered in the X-ray path.
- FIG. 5 would have the guide shoe 12 to be moved by 90 ° upwards, in FIG. 8 90 ° down.
- FIG. 9 shows one opposite FIG. 8 pivoted position of the X-ray system 7, 8, as the position FIG. 7 in proportion to the FIG. 5 . Similar comments apply. Finally shows FIG. 10 a pivoting of the X-ray system 7, 8 with respect to the position FIG. 8 with a different sense of rotation, but about the same pivot axis. Here the lithotripter 13 is brought into the park position.
- FIGS. 11-14 correspond as a top view first FIG. 1b , where they show different adjustment options of the C-arm 6.
- a first vertical adjustment option already shows FIG. 1b ,
- FIG. 11 is the C-arm 6 in contrast to both on the basis of Figures 7-10 described axis has been moved as well as about a further axis of rotation, the latter running in the figure from bottom left to top right and obliquely to the paper plane. It thus lies with its horizontal component parallel to the previously used for explanation horizontal connecting line between on the one hand, the X-ray source 8 and the image pickup device 7 and on the other hand, the stator 3, based on the vertical radiation as in FIG. 1b , The corresponding mechanical axis of rotation 14 is in FIG. 5 located.
- the combination of both rotational movements leads to an approximated cranio-caudal position, that is to say a direction of irradiation moved from the vertical in the direction of the longitudinal axis of the patient.
- FIG. 12 shows a precisely reversed movement, again with a combination of both axes of rotation.
- FIGS. 11-14 is also in addition to FIG. 1b not only the shockwave lithotripter 13, which has already been explained above, but also a U-shaped cut-out region 15 in the patient couch 2 in the abdominal area of the patient. This part 15 of the patient bed can be removed to approximate the lithotripter 13 to the patient as in Figure 4c .
- FIG. 5 and FIG. 7 and can be used again if necessary.
- FIG. 13 again shows a combination of both axes of rotation, but here with a resulting transmission direction, which is moved relative to the vertical in the direction of the transverse direction of the patient, ie a so-called. Lateral tilting.
- FIGS. 11-14 illustrate in certain angular ranges arbitrary tilting positions, which can be achieved with the device according to the invention, and where the oblique arrangement of the stator 5 relative to the patient bed 1 and the oblique arrangement of the axis of rotation 14 relative to the horizontal is not in the way.
Abstract
Description
Die vorliegende Erfindung bezieht sich auf eine Druckwellentherapievorrichtung mit integrierter Röntgenanlage.The present invention relates to a pressure wave therapy device with integrated X-ray system.
Druckwellen, d. h. mechanische und gelegentlich auch als "akustisch" bezeichnete Wellen werden in verschiedener Weise zur therapeutischen Behandlung eingesetzt. Besonders wichtig und historisch betrachtet auch Ausgangspunkt der Entwicklung ist die Stoßwellenlithotripsie, also die Zerkleinerung von Körperkonkrementen, insbesondere Steinen, mit fokussierten Druckwellen großer Amplituden und mit steilen Anstiegsflanken. Hier werden einzelne Pulse auf das Konkrement gerichtet, deren erste, einer Kompression entsprechende "Halbwelle" hinsichtlich Flankensteilheit und Amplitude sowie therapeutischer Wirkung dominiert, wohingegen bereits die nächste nachfolgende Halbwelle, die einer Expansion entspricht, deutlich weniger ausgeprägt ist. Solche Pulse werden regelmäßig wiederholt angewendet.Pressure waves, d. H. mechanical and sometimes also referred to as "acoustic" waves are used in various ways for therapeutic treatment. Particularly important and historically also the starting point of the development is the shock wave lithotripsy, ie the crushing of body calculi, especially stones, with focused pressure waves of large amplitudes and with steep rising edges. Here, individual pulses are directed to the calculus whose first "half-wave" corresponding to compression dominates in terms of edge steepness and amplitude as well as therapeutic effect, whereas already the next subsequent half-wave, which corresponds to an expansion, is significantly less pronounced. Such pulses are used repeatedly on a regular basis.
Vergleichbare Verfahren mit Stoßwellen sind auch für andere Indikationen bekannt, etwa zur Beaufschlagung von schlecht heilenden Knochenbrüchen.Similar methods with shock waves are also known for other indications, such as for the treatment of poorly healing bone fractures.
Daneben betrifft die Erfindung aber auch Druckwellentherapien mit eigentlichen, also fortgesetzt oszillierenden Wellen. Diese können in fokussierter Weise zur Erwärmung von Körpergewebe eingesetzt werden, etwa zur sog. thermischen Ablation von Tumoren.In addition, however, the invention also relates to pressure wave therapies with actual, ie continuously oscillating waves. These can be used in a focused manner for heating body tissue, for example for the so-called thermal ablation of tumors.
Obwohl auch Therapien mit nicht fokussierten Druckwellen bekannt sind, richtet sich die vorliegende Erfindung auf Anwendungen mit fokussierten Wellen (wobei Pulse inbegriffen sein sollen, vgl. oben). Wenngleich die Abgrenzung zwischen fokussierten und nicht fokussierten Wellen Schwierigkeiten bereiten kann, soll es im Folgenden jedenfalls nur um solche Therapien gehen, bei denen die Druckwellen bewusst auf eine mehr oder weniger ausgedehnte Körperregion konzentriert werden, um erhöhte Intensitäten, Drücke oder Flankensteilheiten zu erzielen.Although unfocused pressure wave therapy is also known, the present invention is directed to focused wave applications (which include pulses, see above). Although the distinction between focused and unfocused waves can be difficult, in the following, in any case, only those therapies are to be used in which the pressure waves are consciously concentrated in a more or less extended body region in order to achieve increased intensities, pressures or edge slopes.
Da bei diesen fokussierenden Therapien die Lokalisierung auf die zu behandelnde Körperregion naturgemäß wesentlich ist, spielt die Einstellung der entsprechenden Vorrichtungen zur richtigen Anordnung des Fokusbereichs im Körper eine entscheidende Rolle. Dies betrifft natürlich zum einen die anfängliche Ortung der und Einstellung auf die zu behandelnde Region, etwa einen Stein. Wenn hier zu große Toleranzen auftreten, wird gesundes Gewebe beschädigt oder unnötig viel gesundes Gewebe in Mitleidenschaft gezogen und andererseits der Therapieerfolg in der eigentlich zu behandelnden Region eingeschränkt oder gefährdet. Man spricht hier auch von der "Navigation".Since localization to the body region to be treated is naturally essential in these focusing therapies, the adjustment of the corresponding devices for the correct arrangement of the focal region in the body plays a decisive role. This, of course, on the one hand, the initial location of and attitude to the region to be treated, such as a stone. If excessive tolerances occur here, healthy tissue is damaged or unnecessarily damaged healthy tissue and, on the other hand, the therapeutic success in the region to be treated is restricted or endangered. One speaks here also of the "navigation".
Erschwerend kommt hinzu, dass die Navigation kein statischer Vorgang sein muss, also Änderungen während der Behandlung auftreten können. Eine wesentliche Ursache sind Bewegungen des Patienten oder Verschiebungen von Organen, insbesondere infolge seiner Atmung.To make matters worse, that the navigation does not have to be a static process, so changes may occur during treatment. A significant cause are movements of the patient or shifts of organs, especially as a result of his breathing.
Zur Navigation können bildgebende Verfahren herangezogen werden, die die zu behandelnde Region von der Umgebung unterscheidbar machen und Navigationsinformationen dazu, also letztlich räumliche Koordinaten, für die Druckwellenvorrichtung zur Verfügung stellen können. Bekannt sind insbesondere die Röntgenortung und auch die Röntgenüberwachung während der Stoßwellenlithotripsie. Wenn beispielsweise der Patient auf einer Patientenliege positioniert worden ist, muss also zunächst genau ermittelt werden, wo die zu behandelnde Region liegt. Hierzu wird konventioneller Weise zunächst eine vertikale Röntgendurchleuchtung durchgeführt. In aller Regel wird die zu behandelnde Region, beispielsweise der Stein, in dem Röntgenbild erscheinen, aber nicht zentriert sein. Man kann dann eine horizontale Verschiebung vornehmen (entweder der Liege oder des Ständers mit der Röntgenanlage) bis der Stein zentriert ist.For navigation imaging methods can be used that make the region to be treated distinguishable from the environment and navigation information, so ultimately spatial coordinates can provide for the pressure wave device available. In particular, X-ray localization and X-ray monitoring during shockwave lithotripsy are known. If, for example, the patient has been positioned on a patient couch, it must first be determined exactly where the area to be treated is located. For this purpose, a vertical X-ray fluoroscopy is conventionally carried out first. As a rule, the region to be treated, for example the stone, will appear in the X-ray image, but not be centered. You can then make a horizontal shift (either the bed or the stand with the X-ray system) until the stone is centered.
Zur dreidimensionalen Ortung einer zu behandelnden Region sind grundsätzlich zwei verschiedene Röntgenaufnahmen aus verschiedenen Richtungen nötig, etwa in einem Winkel von 30° zueinander. Also wird eine zweite Röntgendurchleuchtung in einer zweiten Richtung vorgenommen, um die richtige Höhe etwa des Steins einstellen zu können, ihn also auf das sog. Isozentrum zu justieren. Hierzu kann beispielsweise die Patientenliege in der Höhe verstellt werden. Erst wenn der Stein dreidimensional zentriert ist und damit im Druckwellenfokus liegt, kann er desintegriert werden.For three-dimensional localization of a region to be treated, two different X-ray images from different directions are basically necessary, for example at an angle of 30 ° to one another. So a second fluoroscopy is done in a second direction to be able to set the correct height of the stone, for example, to adjust it to the so-called isocenter. For this purpose, for example, the patient bed can be adjusted in height. Only when the stone is three-dimensional centered and thus lies in the pressure wave focus, it can be disintegrated.
Grundsätzlich kann aber eine Röntgenaufnahme in nur einer Richtung mit anderen bildgebenden Verfahren oder anderen nicht bildgebenden Ortungsmöglichkeiten kombiniert werden. Es kann auch Fälle geben, in denen aus anatomischen Gründen eine zweidimensionale Ortung mit einer Röntgenabbildurigsrichtung ausreicht.In principle, however, an X-ray image in only one direction can be combined with other imaging methods or other non-imaging detection possibilities. There may also be cases in which, for anatomical reasons, a two-dimensional location with an X-ray image direction suffices.
Jedenfalls ist häufig eine kombinierte Anwendung von Röntgendiagnostik und Druckwellentherapie gewünscht. Hierzu sind kombinierte Anlagen bekannt, die Röntgenanlagen, auch in der Abbildungsrichtung verstellbare Röntgenanlagen mit Druckwellentherapiegeräten, insbesondere Stoßwellenlithotriptern, kombinieren.In any case, a combined application of X-ray diagnostics and pressure wave therapy is often desired. For this purpose, combined systems are known, the X-ray systems, also in the imaging direction adjustable X-ray systems with pressure wave therapy devices, in particular Stoßwellenlithotriptern combine.
Der vorliegenden Erfindung liegt davon ausgehend das Problem zugrunde, eine hinsichtlich der Gebrauchseigenschaften verbesserte Vorrichtung dieses Typs anzugeben.The present invention is based on the problem to provide an improved in terms of performance characteristics device of this type.
Dieses Problem wird gelöst durch eine Vorrichtung zur Druckwellentherapie am menschlichen oder tierischen Körper mit einem fokussierenden Druckwellentherapiegerät, einer integrierten Röntgenanlage, deren Röntgenquelle und Bildaufnahmeeinrichtung jeweils an Tragearmen an einem Ständer befestigt sind, und einer Patientenliege neben dem Ständer, wobei die Röntgenanlage und das Druckwellentherapiegerät zur Erfassung eines Abdominalbereichs eines Patienten auf der Patientenliege ausgelegt sind und die Röntgenanlage den Abdominalbereich vertikal durchstrahlen kann, dadurch gekennzeichnet, dass die Vorrichtung dazu ausgelegt ist, dass der Ständer einerseits und die Röntgenquelle und die Bildaufnahmeeinrichtung der Röntgenanlage andererseits bei der vertikalen Durchstrahlung des Abdominalbereichs in vertikaler Projektion eine Verbindungslinie bilden, die zu einer Längsachse der Patientenliege einen Winkel von höchstens 75° bildet.This problem is solved by a device for pressure wave therapy on human or animal body with a focusing pressure wave therapy device, an integrated X-ray system, the X-ray source and image pickup device are each attached to support arms on a stand, and a patient bed next to the stand, the X-ray system and the pressure wave therapy device for Detecting an abdominal region of a patient are designed on the patient bed and the X-ray system can radiate vertically through the abdominal area, characterized in that the device is designed so that the stand on the one hand and the X-ray source and the image pickup device of the X-ray system on the other hand in the vertical irradiation of the abdominal region in vertical Projection form a connecting line which forms an angle of at most 75 ° to a longitudinal axis of the patient bed.
Daneben richtet sich die Erfindung auch auf vorteilhafte Verwendungen dieser Vorrichtung und bevorzugte Ausgestaltungen gemäß den abhängigen Ansprüchen. In der folgenden Beschreibung wird nicht mehr explizit zwischen der Vorrichtungskategorie und der Verwendungskategorie unterschieden, so dass die Beschreibung grundsätzlich für beide Anspruchkategorien relevant ist.In addition, the invention is also directed to advantageous uses of this device and preferred embodiments according to the dependent claims. In the following description is no longer explicitly between the device category and the usage category so that the description is basically relevant to both claim categories.
Die Grundidee der Erfindung liegt darin, die räumlichen Gegebenheiten beim Einsatz einer kombinierten Druckwellentherapie- und Röntgenvorrichtung zu verbessern. Dabei ist vor allem der Zugang zum Patienten von Interesse, und zwar bei dieser Erfindung zum Abdominalbereich, also Bauchbereich und Unterleib. Konventionelle Vorrichtungen weisen einen Ständer direkt neben der Patientenliege auf, der die Röntgenanlage an Armen trägt. Dieser Ständer steht an einer Seite neben der Patientenliegenmitte und versperrt damit den Zugang zu dem Abdominalbereich von dieser Seite. In vielen Fällen ist aber ein Zugang von beiden Seiten von Vorteil. Neben der besseren Zugänglichkeit durch eine Mehrzahl von Personen, etwa Arzt und Krankenschwester oder Pfleger, können auch seitliche Bereiche des Patienten auf beiden Seiten behandlungsbedürftig sein, beispielsweise beide Nieren. In diesen Fällen möchte der Arzt insbesondere bei Unterstützung durch einen äußeren Nierenzugang gerne direkt an der gerade behandelten Seite stehen. Daher wird der Patient bei der Verwendung von konventionellen Vorrichtungen beim Wechsel der behandelten Seite umgelagert.The basic idea of the invention is to improve the spatial conditions when using a combined pressure wave therapy and X-ray device. In this case, access to the patient is of particular interest, specifically in this invention for the abdominal region, ie abdominal region and abdomen. Conventional devices have a stand directly next to the patient bed, which carries the X-ray system on arms. This stand stands on one side next to the patient's couch center, blocking access to the abdominal area from this side. In many cases, access from both sides is an advantage. In addition to better accessibility by a plurality of persons, such as the doctor and nurse or caregiver, lateral areas of the patient on both sides may need treatment, for example, both kidneys. In these cases, the doctor would like to stand directly on the side being treated, especially when assisted by external kidney access. Therefore, when using conventional devices, the patient is rearranged when changing the treated side.
Erfindungsgemäß kann eine außermittige Anordnung des Ständers erreicht werden, also neben der Patientenliege und auch an einer ihrer Längsseiten, jedoch nicht neben dem Abdominalbereich. In Betracht kommt also eine Anordnung neben dem Kopfbereich oder neben dem Fußbereich.According to the invention, an eccentric arrangement of the stand can be achieved, ie next to the patient bed and also on one of its longitudinal sides, but not next to the abdominal area. An arrangement next to the head area or next to the foot area is therefore possible.
Konkretisiert wird dies durch die Angabe des Winkels zwischen zwei charakteristischen Linien. Die eine Linie ist eine in der Horizontalen, also der vertikalen Projektion, gedachte Verbindungslinie zwischen dem Ständer und der Röntgenquelle und der Röntgenbildaufnahmeeinrichtung bei vertikaler Durchstrahlrichtung der Röntgenanlage. Diese Linie steht für die Längserstreckung des Röntgenanlagenaufbaus an dem Ständer. Die andere Linie ist die Längsrichtung der Patientenliege, also vom Kopfbereich zum Fußbereich bzw. umgekehrt. Zwischen beiden Linien soll erfindungsgemäß ein Winkel von höchstens 75° bestehen, wohingegen der Stand der Technik hier einen Winkel von 90° vorsieht. Da von einer vertikalen Ausrichtung der Röntgenanlage bei Durchstrahlung des Abdominalbereichs ausgegangen wird, bedeutet diese Winkelangabe eine Quantifizierung der erfindungsgemäßen exzentrischen Anordnung. Besonders bevorzugt sind Winkel von höchstens 70°, 65° oder sogar höchstens 60°.This is substantiated by specifying the angle between two characteristic lines. The one line is a horizontal line, ie the vertical projection, imaginary connecting line between the stator and the X-ray source and the X-ray image recording device in the vertical transmission direction of the X-ray system. This line represents the longitudinal extension of the X-ray system structure on the stand. The other line is the longitudinal direction of the patient bed, ie from the head area to the foot area or vice versa. According to the invention, an angle of at most 75 ° should exist between the two lines, whereas the state of the art here provides an angle of 90 °. Since a vertical alignment of the X-ray system when radiating the abdominal region is assumed, means this angle is a quantification of the eccentric arrangement according to the invention. Particularly preferred are angles of at most 70 °, 65 ° or even at most 60 °.
Das Personal kann nun den Abdominalbereich beider Behandlung von beiden Seiten erreichen. Bei einer Anordnung des Ständers neben dem Kopfbereich bleiben noch die Fußseite der Behandlungsliege und die entgegengesetzte Seite der Behandlungsliege im Kopfbereich frei, insbesondere für die Anästhesie, die ja einen Kopfzugang benötigt. Bei einer demgegenüber noch günstigeren Anordnung neben dem Fußbereich bleibt der Röntgenquellenbereich von drei Seiten zugänglich, jedenfalls was die Röntgenanlage betrifft.The staff can now reach the abdominal area of both treatment from both sides. In an arrangement of the stand next to the head area still remain the foot side of the treatment table and the opposite side of the treatment table in the head area free, especially for anesthesia, which indeed requires a head access. In contrast, even more favorable arrangement next to the foot area of the X-ray source area remains accessible from three sides, at least as far as the X-ray system.
Wichtig ist, dass die erfindungsgemäße Anordnung für die kombinierte Vorrichtung lediglich eine Eignung bedeutet. Die Vorrichtung kann durchaus auch dazu geeignet sein, abweichend aufgebaut oder verwendet zu werden. Die konventionellen Vorrichtungen andererseits sind für die erfindungsgemäße Anordnung nicht geeignet.It is important that the arrangement according to the invention for the combined device means only a suitability. The device may also be suitable for deviating construction or use. On the other hand, the conventional devices are not suitable for the arrangement according to the invention.
Bevorzugt richtet sich die Erfindung zusätzlich auf die Verwendung der erfindungsgemäßen Vorrichtung, bei der die entsprechende Anordnung vorliegt.Preferably, the invention is additionally directed to the use of the device according to the invention, in which the corresponding arrangement is present.
Bei der erfindungsgemäßen Vorrichtung kann die Patientenliege verfahrbar sein und/oder der Ständer verfahrbar sein, um im Einzelfall eine optimale Geometrie zu finden. Insbesondere können diese Bestandteile auch verfahrbar sein, um sie z. B. von Zimmer zu Zimmer bewegen zu können. Beispielsweise könnte eine Mehrzahl von Patientenliegen Verwendung finden, wobei die Patienten auf außerhalb des Bereichs der Röntgenanlage und des Druckwellentherapiegeräts befindlichen Patientenliegen vorbereitet und auf diesen zur Behandlung gefahren werden, wenn andere Patienten auf anderen Patientenliegen fertig behandelt sind. Auch könnte der Ständer mit Röntgenanlage und Druckwellentherapiegerät von Raum zu Raum bewegt werden, um in verschiedenen Räumen oder auch verschiedenen Stationen oder sogar, bei einem Fahrzeugtransport, in verschiedenen Krankenhäusern oder Arztpraxen eingesetzt zu werden.In the device according to the invention, the patient bed can be moved and / or the stand can be moved in order to find an optimal geometry in individual cases. In particular, these components can also be moved to them z. B. move from room to room. For example, a plurality of patient beds could be used, with the patients being prepared for and being placed on patient beds located outside the area of the x-ray unit and the pressure wave therapy unit, when other patients on other patient beds are finished. The stand could also be moved from room to room with X-ray equipment and wave therapy equipment to be used in different rooms or at different stations or even in a vehicle transport, in various hospitals or medical practices.
Bei einer bevorzugten Ausgestaltung ist die Röntgenanlage in ihrer Abbildungsrichtung verstellbar, und zwar durch ein Verschwenken eines Bogens, der aus den Armen gebildet ist, an denen die Röntgenquelle und die Bildaufnahmeeinrichtung montiert sind. Dadurch wird, wieder in vertikaler Projektion betrachtet, entweder die Röntgenquelle oder die Bildaufnahmeeinrichtung näher zum Ständer und das andere Teil davon weg bewegt. Bevorzugt ist hierbei eine Drehbewegung um eine horizontale Achse, die also senkrecht zu der beschriebenen Verbindungslinie zwischen Röntgenquelle und Bildaufnahmeeinrichtung einerseits und Ständer andererseits in der vertikalen Projektion liegt. Allerdings kann die Schwenkbewegung auch anders ausgeführt sein, also nicht mit fester Drehachse. Bei den bevorzugten Varianten mit einer zeitlich konstanten Drehachse läuft diese vorzugsweise durch den Fokusbereich des Druckwellengeräts.In a preferred embodiment, the X-ray system is adjustable in its imaging direction, by pivoting an arc, which is formed from the arms on which the X-ray source and the image pickup device are mounted. As a result, again viewed in vertical projection, either the X-ray source or the image pickup device is moved closer to the stand and the other part thereof away. In this case, a rotational movement about a horizontal axis which is perpendicular to the described connection line between the X-ray source and the image recording device on the one hand and the stator on the other hand in the vertical projection is preferred. However, the pivoting movement can also be designed differently, ie not with a fixed axis of rotation. In the preferred variants with a time-constant axis of rotation, this preferably passes through the focus area of the pressure wave device.
In dieser Ausgestaltung kann also die Röntgenabbildungsrichtung aus der genau vertikalen Lage verkippt werden. Durch die beschriebene Verstellmöglichkeit kann eine für die Druckwellentherapie relevante Region im Abdominalbereich geortet werden. Somit ermöglicht die Erfindung bei dieser Ausgestaltung auch eine reine Röntgenortung und Röntgennavigation.In this embodiment, therefore, the X-ray imaging direction can be tilted out of the exactly vertical position. As a result of the adjustment described, a region relevant for pressure wave therapy can be located in the abdominal area. Thus, the invention also allows in this embodiment, a pure X-ray location and X-ray navigation.
Eine weitere bevorzugte Ausgestaltung sieht eine zusätzliche Achse der Röntgenanlage vor, die dadurch realisiert ist, dass der Bogen verdrehbar an der Säule montiert ist. Erfindungsgemäß liegt diese Achse vorzugsweise nicht horizontal, sondern schräg. Bevorzugt ist ein Winkelbereich zwischen dieser Drehachse und der Horizontalen zwischen 30° und 60°, insbesondere zwischen 40° und 50°. Da Rotationen um die Röntgenabbildungsachse selbst nicht sinnvoll sind, sind mit diesen zwei rotatorischen Freiheitsgraden im Prinzip beliebige Winkelpositionen einstellbar, jedenfalls soweit es die baulichen Verhältnisse, insbesondere der Platz über und unter der Patientenliege und die Ausdehnung der Röntgenquelle und der Röntgenbildaufnahmeeinrichtung, zulassen. Insbesondere können laterale Verkippungen der Röntgenstrahlachse, also um die Patientenlängsachse verdreht, cranio-caudale Verkippungen, also um eine horizontale Achse quer zum Patienten verdreht, und Strahlrichtungsumkehrungen realisiert werden. Die cranio-caudale Position wird dabei i. d. R. nur angenähert erreicht, aber dennoch so bezeichnet.A further preferred embodiment provides an additional axis of the X-ray system, which is realized in that the arc is rotatably mounted on the column. According to the invention, this axis is preferably not horizontal, but oblique. An angular range between this axis of rotation and the horizontal is preferably between 30 ° and 60 °, in particular between 40 ° and 50 °. Since rotations about the X-ray imaging axis itself are not meaningful, in principle arbitrary angular positions can be set with these two rotational degrees of freedom, at least as far as the structural conditions, in particular the space above and below the patient bed and the extent of the X-ray source and the X-ray image recording device allow. In particular, lateral tilting of the X-ray axis, that is to say rotated about the patient's longitudinal axis, cranio-caudal tilting, that is to say about a horizontal axis transversely to the patient, and beam direction inversions can be realized. The cranio-caudal position is usually only approximately reached, but nevertheless so designated.
Bei weiteren bevorzugten Ausgestaltungen ist auch das Druckwellentherapiegerät beweglich. Vorzugsweise ist es an dem Bogen montiert und entlang dem Bogen verfahrbar, wobei diese Ausgestaltung wiederum vorzugsweise isozentrisch ist. Der Mittelpunkt des Verfahrweges des Druckwellentherapiegeräts, der Schnittpunkt aller möglichen Röntgenstrahlachsen und der Fokusbereich des Druckwellentherapiegeräts fallen also vorzugsweise zusammen.In further preferred embodiments, the pressure wave therapy device is movable. Preferably, it is mounted on the sheet and moved along the arc, which configuration is again preferably isocentric. The center of the travel path of the wave therapy therapy device, the intersection of all possible X-ray axes and the focus range of the wave therapy therapy device thus preferably coincide.
Darüber hinaus ist es günstig, wenn das Druckwellentherapiegerät eine Parkposition und eine Arbeitsposition einnehmen kann. Bei der Arbeitsposition liegt der Fokusbereich im Röntgenstrahlengang. In der Parkposition befindet sich das Druckwellentherapiegerät ganz außerhalb des Röntgenstrahlengangs, soweit dieser für die Abbildung genutzt wird, um möglichst wenig zu stören. Idealerweise ist der Bewegungsmechanismus für die Bewegungen zwischen diesen beiden Positionen ebenfalls entlang dem Bogen verfahrbar und funktioniert in den verschiedenen Schwenkpositionen des Druckwellentherapiegeräts. Damit kann das Druckwellentherapiegerät während des Schwenkvorgangs aus dem Liegenbereich herausgezogen sein und in bestimmten therapeutisch relevanten Positionen, etwa unter der Liege mit vertikaler Beaufschlagungsrichtung nach oben, lateral neben dem Patienten knapp über der Liege mit horizontaler Beaufschlagungsrichtung und über der Liege mit vertikaler Beaufschlagungsrichtung nach unten, in eine jeweilige Arbeitsposition verfahrbar sein.Moreover, it is advantageous if the pressure wave therapy device can assume a parking position and a working position. In the working position, the focus area is in the X-ray path. In the parking position, the pressure wave therapy device is located entirely outside the X-ray path, as far as it is used for imaging, in order to disturb as little as possible. Ideally, the movement mechanism for the movements between these two positions is also movable along the arc and operates in the various pivotal positions of the wave therapy device. Thus, the pressure wave therapy device may be pulled out of the couch during the pivoting operation and in certain therapeutically relevant positions, such as under the couch with vertical Beaufschlagungsrichtung up, laterally next to the patient just above the couch with horizontal direction and above the couch with vertical direction of downward loading, be movable in a respective working position.
Zudem ist es von Vorteil, laterale Verstellmöglichkeiten vorzusehen, um, insbesondere bei der bevorzugten isozentrischen Ausführung, die interessierende Region in dem Abdominalbereich in den von der Röntgenanlage und dem Druckwellentherapiegerät erfassten Bereich zu bringen. Dabei können zwei horizontale Verstellrichtungen vorgesehen sein. Letztlich kommt es auf die Relativanordnung zwischen dem Ständer und der Patientenliege an, so dass die Patientenliege und/oder der Ständer verstellt werden können. Bevorzugt ist eine Ständerverstellung, weil sich damit keine Erschütterungen für den Patienten ergeben und nicht auf etwaige von ihm ausgehende Leitungen in Zusammenhang mit Kathetern, der Anästhesie oder anderem, geachtet werden muss. Mit einer Ständerverstellung ist dabei nicht unbedingt ein Verfahren des Ständers insgesamt über den Boden gemeint. Es genügt für die Ständerverstellung, wenn die gemeinsame Konstruktion von Druckwellentherapiegerät und Röntgenanlage, also insbesondere der Bogen, verfahren wird. Diese Verstellmöglichkeit besteht vorzugsweise auch vertikal.In addition, it is advantageous to provide lateral adjustment options in order, in particular in the preferred isocentric embodiment, to bring the region of interest in the abdominal region into the region covered by the X-ray system and the pressure wave therapy device. In this case, two horizontal adjustment directions can be provided. Ultimately, it depends on the relative arrangement between the stand and the patient bed, so that the patient bed and / or the stand can be adjusted. Preference is given to a stand adjustment, because this results in no shock to the patient and does not have to be paid to any outgoing lines in connection with catheters, anesthesia or other. With a stand adjustment is not necessarily meant a method of the stand as a whole across the floor. It is sufficient for the stand adjustment when the joint construction of pressure wave therapy device and X-ray equipment, so in particular the bow, is moved. This adjustment is preferably also vertical.
Wenn das Druckwellentherapiegerät jedenfalls in der Ebene des Röntgenbildes bereits auf einen bzgl. der Röntgenbilder festgelegten Ort fokussiert ist, etwa die Mitte des Röntgenbildes, kann durch die beschriebene Reiativeinstellung zwischen Ständer und der Patientenliege das Druckwellentherapiegerät insoweit schon auf die zu behandelnde Region eingestellt werden. I. d. R. ist dann eine zusätzliche Einstellung in der Richtung der Röntgenaufnahmeeinrichtung notwendig. Für die Bestimmung der Höheneinstellung des Therapiegebietes soll bei reiner Röntgenortung eine weitere Durchstrahlungsrichtung, beispielsweise verschieden von der vertikalen Richtung, bevorzugt unter 30° zur Vertikalen, einstellbar sein. Dies kann etwa erreicht werden durch eine Drehung des C-Bogens. Die Einstellung selbst kann ebenfalls durch eine Einstellung des Druckwellentherapiegeräts (incl. Röntgeneinrichtung)oder auch durch ein entsprechendes Nachjustieren, etwa eine Höhenanpassung, der Patientenliege erfolgen. Bevorzugt wird die Höheneinstellung der Liege, weil damit auch eine günstige Höheneinstellung für den Aufstieg des Patienten erreicht werden kann.If the pressure wave therapy device is already focused in any case in the plane of the X-ray image on a fixed with respect to the X-ray images, such as the center of the X-ray image, the pressure wave therapy device can already be adjusted to the region to be treated by the described Reiativeinstellung between stand and the patient bed. I. d. R. is then an additional adjustment in the direction of the X-ray device necessary. For the determination of the height adjustment of the therapy area, in the case of pure X-ray localization, a further transmission direction, for example different from the vertical direction, preferably below 30 ° to the vertical, should be adjustable. This can be achieved for example by a rotation of the C-arm. The setting itself can also be done by a setting of the pressure wave therapy device (including X-ray device) or by a corresponding readjustment, such as a height adjustment, the patient bed. Preferably, the height adjustment of the lounger, because it also a favorable height adjustment for the rise of the patient can be achieved.
Schließlich ist eine hohle Ausführung des Druckwellentherapiegeräts bevorzugt. Dies gilt insbesondere für Stoßwellenlithotripter. Die Druckwellenquelle kann dabei eine Hohlspule sein. Jedenfalls soll ein Durchtritt der Röntgenstrahlen durch das Druckwellentherapiegerät möglich sein, vorzugsweise zumindest axial. Damit können die Röntgenanlage und das Druckwellentherapiegerät bei jeweils vertikaler Arbeitsrichtung gleichzeitig betrieben werden. Hierbei ist es übrigens günstig, bei der geschilderten Verstellbarkeit das Druckwellentherapiegerät in der Nähe der Röntgenquelle anzuordnen, weil damit die durch die Hohlgeometrie evtl. unvermeidliche Einschränkung des Bildquerschnitts der Röntgenanlage geringer ist als bei einer Anordnung in der Nähe der Bildaufnahmeeinrichtung, beispielsweise des Bildverstärkers.Finally, a hollow design of the wave therapy therapy device is preferred. This is especially true for shockwave lithotripters. The pressure wave source can be a hollow coil. In any case, a passage of the X-rays through the pressure wave therapy device should be possible, preferably at least axially. Thus, the X-ray system and the pressure wave therapy device can be operated simultaneously in each vertical working direction. Incidentally, it is favorable to arrange the pressure wave therapy device in the vicinity of the X-ray source with the described adjustability because the restriction of the image cross section of the X-ray system which may be unavoidable due to the hollow geometry is smaller than with an arrangement in the vicinity of the image recording device, for example the image intensifier.
Vorzugsweise existiert sogar eine weitere, gegenüber der axialen Richtung etwas geneigte mögliche Durchtrittsrichtung für Röntgenstrahlen durch das Druckwellentherapiegerät, vorzugsweise für eine lateral verkippte zweite Röntgenabbildung bei einer Anordnung des Druckwellentherapiegeräts in seiner Arbeitsposition.Preferably, there is even another possible passage direction for X-rays through the pressure wave therapy device, which is slightly inclined with respect to the axial direction, preferably for a laterally tilted second X-ray image in an arrangement of the wave therapy device in its working position.
Die laterale Anordnung des Druckwellentherapiegeräts stört die Röntgenabbildung übrigens i. d. R. nicht, jedenfalls dann nicht, wenn diese nahe der vertikalen Abbildungsachse oder auch mit einer cranio-caudalen Position erfolgt.Incidentally, the lateral arrangement of the pressure wave therapy device disturbs the X-ray image i. d. R. not, at least not if it is close to the vertical axis or even with a cranio-caudal position.
Der Ständer kann einen Fuß mit in der Richtung der Verbindungslinie zwischen Röntgenquelle und Bilderzeugungseinrichtung einerseits und Ständer andererseits etwas größerer Ausdehnung aufweisen, um den Schwerpunkt der Gesamtkonstruktion abstützen zu können. Dieser Fuß kann mit seiner Verkleidung ein nahes Heranrücken an die Patientenliege erschweren, weil er mit Stützkonstruktionen der Patientenliege kollidiert oder jedenfalls den möglicherweise für andere Zwecke benötigten Raum unter dem Patienten einschränkt. In diesem Zusammenhang ist der Ständer vorzugsweise in dem relevanten Bereich, also dem der Röntgenquelle und der Röntgenbildaufnahmeeinrichtung zugewandten Bereich, angeschrägt ausgestaltet. Damit kann eine sinnvolle Abstützung mit einer in dem problematischen Bereich möglichst schlanken Bauform kombiniert werden. Die Anschrägung der Verkleidung soll dabei zumindest die Hälfte der der Röntgenquelle und der Röntgenbildaufnahmeeinrichtung zugewandten Seite umfassen, der nicht angeschrägte Bereich soll also höchstens die Hälfte ausmachen. Bevorzugt ist ein nicht angeschrägter Rest mittig vorgesehen und sind zwei Anschrägungen an beiden Seiten davon vorgesehen. Die Anschrägungen müssen nicht gerade Flanken haben, sollen aber jedenfalls auf schräge Winkel im Bereich zwischen 10° und 60°, vorzugsweise mindestens 15° und vorzugsweise höchstens 45°, hin angeschrägt sein. Seitlich von einem nicht angeschrägten Bereich von höchstens der Hälfte der betrachteten Verkleidungsfront sollen also entsprechende Winkel erreicht werden. Damit kann der Ständer in der erfindungsgemäßen schrägen Orientierung recht nah an die Patientenliege herangerückt werden, ohne wesentlich oder überhaupt unter die Patientenliege zu ragen und ohne die Bewegungsfreiheit (besonders im Fußbereich) des Behandlers, der seitlich an der Liege steht, zu behindern. Bei einer doppelseitigen Anschrägung gilt dies auch in verschiedenen Anordnungen, also rechts oder links von der Patientenliege bzw. neben dem Kopf- oder dem Fußbereich. Zur Veranschaulichung wird auf das Ausführungsbeispiel verwiesen.On the other hand, the stand can have a foot with a somewhat larger extension in the direction of the connecting line between the X-ray source and the imaging device on the one hand and the stand in order to be able to support the center of gravity of the overall construction. This foot can make it difficult to get close to the patient bed with its cladding, because it collides with support structures of the patient bed or at least restricts the space possibly required for other purposes under the patient. In this context, the stand is preferably bevelled in the relevant area, that is to say the area facing the X-ray source and the X-ray image recording device. Thus, a meaningful support can be combined with a slim as possible in the problematic area design. The bevel of the cladding should thereby comprise at least half of the X-ray source and the X-ray image recording device facing side, the non-tapered region should therefore make up at most half. Preferably, a non-tapered remainder is provided centrally and two chamfers are provided on both sides thereof. The chamfers need not have straight flanks, but should in any case be beveled at an angle in the range between 10 ° and 60 °, preferably at least 15 ° and preferably at most 45 °. Side of a non-tapered area of at most half of the considered front panel so appropriate angle should be achieved. Thus, the stand in the oblique orientation according to the invention can be moved quite close to the patient bed without substantially or even protrude below the patient bed and without obstructing the freedom of movement (especially in the foot) of the practitioner who is on the side of the couch. In the case of a double-sided chamfer, this also applies in various arrangements, that is, to the right or left of the patient bed or next to the head or foot area. For the sake of illustration, reference is made to the exemplary embodiment.
Eine weitere bevorzugte Ausgestaltung des Ständers weist ein Geräteregal für weitere medizintechnische Geräte auf, etwa für Endoskopiegeräte oder Steuerungs- und Auswertegeräte, eine Ultraschalldiagnostikeinheit u. Ä. Dieses Geräteregal (oder "Rack") ist in dem Sinn "oben" angeordnet, als es zumindest teilweise höher als die Patientenliege, d. h. die Patientenebene, montiert ist. Es kann damit aus dem Fußbereich herausgehalten werden, der möglicherweise für andere Dinge benötigt wird und leichter zugänglich und damit einfacher zu bedienen oder zu reinigen ist. Schließlich ist diese Anordnung ergonomisch günstiger zur Bedienung der Geräte als eine Anordnung unter Hüfthöhe. Bei einer besonders bevorzugten Ausgestaltung ist das Geräteregal auf dem eigentlichen Ständer angeordnet, wie das Ausführungsbeispiel zeigt.A further preferred embodiment of the stand has a device shelf for other medical devices, such as for endoscopy or control and Evaluation devices, an ultrasonic diagnostic unit u. Ä. This rack (or "rack") is arranged "up" in the sense that it is mounted at least partially higher than the patient bed, ie the patient level. It can thus be kept out of the foot area, which may be needed for other things and is more accessible and thus easier to use or clean. Finally, this arrangement is ergonomically more favorable for the operation of the devices as an arrangement under waist height. In a particularly preferred embodiment, the device shelf is arranged on the actual stand, as the embodiment shows.
Die Patientenliege weist bevorzugt eine exzentrische Säule auf, um den Bereich unterhalb des Abdominalbereichs des Patienten freizulassen. Damit kann beispielsweise ein Teil der Röntgenanlage unter den Abdominalbereich geschoben werden. Zusätzlich weist die Patientenliege einen von der exzentrischen Säule ausgehenden Stützfuß auf, der sich relativ flach auf dem Boden bis mindestens in den Abdominalbereich erstreckt, um eine ausreichende Stabilität der Patientenliege sicherzustellen. Diese Ausgestaltung eignet sich besonders auch für verfahrbare Liegen, die nicht fest auf einem Boden verschraubt sind. Auch hier wird zur Veranschaulichung auf das Ausführungsbeispiel verwiesen.The patient couch preferably has an eccentric column to clear the area below the abdominal area of the patient. Thus, for example, a part of the X-ray system can be pushed under the abdominal area. In addition, the patient bed has a supporting foot extending from the eccentric column, which extends relatively flat on the floor to at least the abdominal area in order to ensure sufficient stability of the patient bed. This embodiment is particularly suitable for movable couches that are not firmly bolted to a floor. Again, reference is made to the illustrative embodiment.
Die Erfindung wird anhand eines Ausführungsbeispiels näher erläutert, wobei die einzelnen Merkmale auch in anderen Kombinationen erfindungswesentlich sein können und sich auf die Vorrichtungskategorie und die Verwendungskategorie beziehen.The invention will be explained in more detail with reference to an exemplary embodiment, wherein the individual features can also be essential to the invention in other combinations and relate to the device category and the use category.
- Figur 1a + bFIG. 1a + b
- zwei Draufsichten auf erfindungsgemäße Vorrichtungen in verschiedener Anordnung,two top views of devices according to the invention in various arrangements,
- Figur 2FIG. 2
-
eine Aufrissansicht der Vorrichtung aus
Figur 1b ohne Druckwellentherapiegerät in Patientenliegenlängsrichtung gesehen,an elevation view of the deviceFIG. 1b without pressure wave therapy device seen in the patient's seat longitudinal direction, - Figur 3FIG. 3
-
eine Seitenansicht der Vorrichtung aus
Figur 2 mit gegenüberFigur 2 umgekehrter Durchstrahlungsrichtung der Röntgenanlage und wieder ohne Druckwellentherapiegerät dargestellt.a side view of the deviceFIG. 2 with oppositeFIG. 2 reversed radiographic direction of the X-ray system and again shown without pressure wave therapy device. - Figur 4a - cFigure 4a - c
-
Aufrissdarstellungen entsprechend
Figur 2 , jedoch mit Druckwellentherapiegerät in verschiedenen Positionen,Aufrissdarstellungen accordinglyFIG. 2 , but with wave therapy device in different positions, - Figuren 5 - 10FIGS. 5 to 10
- Seitenansichten des Ständers mit verschiedenen Positionen des Bogens.Side views of the stand with different positions of the bow.
- Figuren 11 - 14FIGS. 11-14
-
Draufsichten entsprechend
Figur 1 b mit verschiedenen C-Bogen-Positionen.Corresponding to plan viewsFigure 1 b with different C-arm positions.
In den
Die Säule 3 stützt sich mit zwei im Wesentlichen zur Längsrichtung der Liege (in
Neben der Patientenliege 1 - 4 steht auf dem Boden ein Ständer 5, der einen im Wesentlichen halbkreisförmigen C-Bogen 6 trägt. An den Enden des C-Bogens 6 befindet sich in den
Die
Die Tragestange 10 läuft durch das Geräteregal 9 hindurch und oben darüber hinaus und trägt an einem Hebelarm zwei große über Berührung bedienbare Flachbildschirme zur Darstellung von Röntgenbildern oder auch Bildern der Videokamera, also aus der Endoskopie, von für den Benutzer wesentlichen Daten, von Ultraschallbildern, etc.The
Man erkennt in
Man erkennt in
In der in
Die Anordnung in
Die
In dieser Position erfolgt die Stoßwellenbehandlung von oben und ist die Röntgenabbildungsrichtung gegenüber
Sowohl in der Position des C-Bogens 6 aus
Die
In
In den
Das Gleiche gilt für
Die
Claims (26)
wobei die Röntgenanlage (7, 8) und das Druckwellentherapiegerät (13) zur Erfassung eines Abdominalbereichs eines Patienten auf der Patientenliege (1) ausgelegt sind und die Röntgenanlage (7, 8) den Abdominalbereich vertikal durchstrahlen kann,
dadurch gekennzeichnet, dass die Vorrichtung dazu ausgelegt ist, dass der Ständer (5) einerseits und die Röntgenquelle (8) und die Bildaufnahmeeinrichtung (7) der Röntgenanlage andererseits bei der vertikalen Durchstrahlung des Abdominalbereichs in vertikaler Projektion eine Verbindungslinie bilden, die zu einer Längsachse der Patientenliege (1) einen Winkel von höchstens 75° bildet.Device for pressure wave therapy on the human or animal body with a focusing pressure wave therapy device (13), an integrated X-ray system (7, 8) whose X-ray source (8) and image recording device (7) are each attached to support arms (6) on a stand (5), and a patient bed (1) next to the stand (5),
wherein the X-ray system (7, 8) and the pressure wave therapy device (13) are designed for detecting an abdominal region of a patient on the patient couch (1) and the X-ray system (7, 8) can vertically scan the abdominal region,
characterized in that the device is designed so that the stand (5) on the one hand and the X-ray source (8) and the image recording device (7) of the X-ray system on the other hand in vertical projection of the abdominal region in vertical projection form a connecting line to a longitudinal axis of the Patient couch (1) forms an angle of at most 75 °.
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP08005803A EP2105098B1 (en) | 2008-03-27 | 2008-03-27 | Pressure wave therapy device with integrated x-ray device |
DE502008001641T DE502008001641D1 (en) | 2008-03-27 | 2008-03-27 | Pressure wave therapy device with integrated X-ray system |
PCT/EP2009/002068 WO2009118133A1 (en) | 2008-03-27 | 2009-03-20 | Shock wave therapy apparatus having an integrated x-ray device |
US12/934,842 US20110028832A1 (en) | 2008-03-27 | 2009-03-20 | Shock wave therapy apparatus having an integrated X-ray device |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
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EP08005803A EP2105098B1 (en) | 2008-03-27 | 2008-03-27 | Pressure wave therapy device with integrated x-ray device |
Publications (2)
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EP2105098A1 true EP2105098A1 (en) | 2009-09-30 |
EP2105098B1 EP2105098B1 (en) | 2010-10-27 |
Family
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EP08005803A Not-in-force EP2105098B1 (en) | 2008-03-27 | 2008-03-27 | Pressure wave therapy device with integrated x-ray device |
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US (1) | US20110028832A1 (en) |
EP (1) | EP2105098B1 (en) |
DE (1) | DE502008001641D1 (en) |
WO (1) | WO2009118133A1 (en) |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
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CN103417260A (en) * | 2013-09-04 | 2013-12-04 | 潘效铮 | Automatic intelligent guide type calculus removing device |
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US11484724B2 (en) | 2015-09-30 | 2022-11-01 | Btl Medical Solutions A.S. | Methods and devices for tissue treatment using mechanical stimulation and electromagnetic field |
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EP0369177A2 (en) * | 1988-10-17 | 1990-05-23 | Storz Medical Ag | Focused acoustic pressure wave generator |
DE4400997A1 (en) * | 1994-01-14 | 1995-07-27 | Siemens Ag | Medical appts with X=Ray diagnostic unit |
WO2000015121A1 (en) * | 1998-09-14 | 2000-03-23 | Storz Medical Ag | Method and device for visualizing the orientation of therapeutic sound waves in an area to be treated or manipulated |
WO2004006786A1 (en) * | 2002-07-10 | 2004-01-22 | Philips Intellectual Property & Standards Gmbh | Therapy combination |
DE10236177A1 (en) * | 2002-08-07 | 2004-03-04 | Dornier Medtech Systems Gmbh | Lithotriptor for treating concretions etc., has therapy unit which can be moved relative to base unit into position which lies outside working range of X-ray apparatus mounted on C-arm |
DE102005040173A1 (en) * | 2005-08-25 | 2007-03-15 | Ziehm Imaging Gmbh | Test object`s concrement lithotripsy treatment method, involves positioning focus of therapy source on target point, carrying out lithotripsy, and positioning C-arch according to determination of treatment in test position |
Family Cites Families (2)
Publication number | Priority date | Publication date | Assignee | Title |
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DE3714397A1 (en) * | 1987-04-30 | 1988-11-10 | Dornier Medizintechnik | UNIVERSAL MEDICAL WORKPLACE |
DE19746956C2 (en) * | 1997-10-23 | 2000-05-11 | Siemens Ag | Medical system comprising an X-ray device and a therapy device with a source of focused acoustic waves |
-
2008
- 2008-03-27 EP EP08005803A patent/EP2105098B1/en not_active Not-in-force
- 2008-03-27 DE DE502008001641T patent/DE502008001641D1/en active Active
-
2009
- 2009-03-20 US US12/934,842 patent/US20110028832A1/en not_active Abandoned
- 2009-03-20 WO PCT/EP2009/002068 patent/WO2009118133A1/en active Application Filing
Patent Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
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EP0369177A2 (en) * | 1988-10-17 | 1990-05-23 | Storz Medical Ag | Focused acoustic pressure wave generator |
DE4400997A1 (en) * | 1994-01-14 | 1995-07-27 | Siemens Ag | Medical appts with X=Ray diagnostic unit |
WO2000015121A1 (en) * | 1998-09-14 | 2000-03-23 | Storz Medical Ag | Method and device for visualizing the orientation of therapeutic sound waves in an area to be treated or manipulated |
WO2004006786A1 (en) * | 2002-07-10 | 2004-01-22 | Philips Intellectual Property & Standards Gmbh | Therapy combination |
DE10236177A1 (en) * | 2002-08-07 | 2004-03-04 | Dornier Medtech Systems Gmbh | Lithotriptor for treating concretions etc., has therapy unit which can be moved relative to base unit into position which lies outside working range of X-ray apparatus mounted on C-arm |
DE102005040173A1 (en) * | 2005-08-25 | 2007-03-15 | Ziehm Imaging Gmbh | Test object`s concrement lithotripsy treatment method, involves positioning focus of therapy source on target point, carrying out lithotripsy, and positioning C-arch according to determination of treatment in test position |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
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CN103417260A (en) * | 2013-09-04 | 2013-12-04 | 潘效铮 | Automatic intelligent guide type calculus removing device |
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DE502008001641D1 (en) | 2010-12-09 |
US20110028832A1 (en) | 2011-02-03 |
EP2105098B1 (en) | 2010-10-27 |
WO2009118133A1 (en) | 2009-10-01 |
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